Given the need to continually “pressure test” the relevance of our operative armamentarium, Franssen et al1 are to be commended for their careful comparison of hepatic arterial infusion pump (HAIP) floxuridine chemotherapy and resection for a controversial disease—multifocal intrahepatic cholangiocarcinoma—in this issue of JAMA Surgery. The controversy relates to the unresolved question of whether this disease is a manifestation of colocated primary tumors or of intrahepatic metastasis.2,3 The possibility of a cure, which is modest but extant after resection of solitary tumors, drops precipitously with multiple tumors—motivating interest in transarterial therapies for this disease.4,5 Unlike transarterial chemoembolization and, to some extent, selective internal radiotherapy, HAIP floxuridine chemotherapy has the potential advantage of targeting both macroscopic tumors and occult lesions that might reside elsewhere in the liver.
Cho CS. Multifocal Intrahepatic Cholangiocarcinoma and Operative Management of Inoperable Disease. JAMA Surg. 2022;157(7):597. doi:10.1001/jamasurg.2022.1305
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